Medical Cannabis: Alleviation of Health Conditions

Crispin Blunt Excerpts

Thursday 4th November 2021 Commons Chamber

[Crispin Blunt (Reigate) (Con)]

I am delighted to follow the hon. Member for Inverclyde (Ronnie Cowan) and have worked with him actively in the past few years on this issue, and I wish we had made more progress. I am delighted to welcome the Minister to her place, answering this debate. I have an interest recorded in the Register of Members’ Financial Interests on this, but it is a non-financial interest. It is in recognition of the fact that I chair an organisation that I have set up, the Conservative Drug Policy Reform Group Ltd, whose objective is to find the resources to bring arguments based on science and research into this debate, on all of drugs policy, and to have this academically peer-reviewed, so that the arguments for the huge challenge of a policy change that is required can be put in a proper, calm way, based on all the available evidence and a proper scientific assessment of that evidence.

I say to the Minister at the beginning of my remarks that this issue is not just about medicine from cannabis. That is one element and one casualty of how we have conducted our nation’s drug policy over the past five or six decades, but it is a huge missed opportunity. My journey into this issue arose as prisons Minister, when I saw the impact of taking a criminal justice approach to drug misuse as the first lever, rather than a public health approach. As I saw at first hand, the cost to the criminal justice system is just enormous. Indeed, the Government’s own statistics talk of a cost in the order of £19 billion a year. When one then thinks that half of acquisitive crime in the UK is driven by drug misuse and drug addiction, we see that we should be asking some serious questions about the whole of our drugs policy.

However, that is a separate debate. It was made clear to me when I became the first Conservative to co-chair the all-party group on drug policy reform, when I decided to make this issue one of my central areas of focus, after I ceased to be chair of the Select Committee on Foreign Affairs, that we needed to focus on the arguments for medicine, which had not been able to be researched and developed because of our drugs policy. Focusing on the arguments associated with prohibition and criminal justice, and the parallels with alcohol in the United States in the 1920s and 1930s, is not where the discussion is; the Government are completely clear on where their policy sits on those issues. There is now a big global debate on those issues, with a Global Commission on Drug Policy reform, but it was put to me that we must focus on getting medicines from cannabis for the people who are suffering because they are not able to get access to it.

I became co-chair of the all-party group in September 2017 and I took the advice I was given by people who had been in this field rather longer than I had, and we got behind the family of Alfie Dingley. A national newspaper had got involved and a petition was signed by 300,000 people. The family had gone to a holiday camp in Holland in order to access medicine from cannabis, because they could not get it in the UK. The Bedrocan oil that Alfie was getting then stopped his epileptic fits, but the family had run out of money, so they had to come back to the UK and they could not access the medicine here. On the day of the presentation of the petition to Downing Street, I was able to ask an urgent question in the House on the matter. The issue was raised with Ministers and we were given assurances that the Dingley family were going to be helped to find their way through the complicated licensing process in order to enable Alfie to be able to access the medicine. Three months later, of course, they still had not got it. The cost of the licence application process—simply buying the licences to access this oil—was £20,000; we are talking about £5,000 a licence, so enormous barriers were put in the way.

Then we had the case of Charlotte Caldwell and her epileptic son Billy, who had been in the United States getting treatment. When they returned to the UK, wisely doing so via Dublin, because she lived in Northern Ireland, her GP gave her a prescription for the medicine she had brought back from the US. When the manufacturer of that medicine changed and it became a Canadian company, she needed a new prescription, at which point it all fell apart. The doctor was told, “You are not allowed to prescribe that medicine for this epileptic child to stop him having his fits.” With the support of Richard Branson and others, Charlotte went to Canada, collected the medicine, came back and presented it to customs at Heathrow on the Monday, when it was confiscated. By the Thursday the boy was in hospital fitting, and his consultants were on the steps of the hospital saying, “It really doesn’t matter. What is unacceptably cruel is to take a medicine that is working off a child.” The current Health Secretary, to his huge credit, then issued a special licence for Billy Caldwell to be able to get his medicine back from customs. That led to the then chief medical officer being invited to offer an opinion as to whether there was anything in this cannabis stuff as far as medicine is concerned. It only took her two weeks to come back with a strongly affirmative answer, based on the evidence available around the world. That then led to the regulations that the Government passed in November 2018, which have not solved the issue. As the hon. Member for Inverclyde said, only three prescriptions have been made on the NHS.

You will be familiar, Madam Deputy Speaker, as we all are in our constituencies, with the position of multiple sclerosis sufferers. There are about 50,000 people in this country growing their own medicine. They are committing quite a serious criminal offence in the process, but they are trying to treat their health condition. What we have failed to do on the back of the regulations passed in November 2018 is get an evidence-based approach to medicine from cannabis, and educate the health service, prescribing doctors and the rest about the potential benefits and how we should have developed a position from the first go at the regulatory change in 2018.

[Dr Julian Lewis (New Forest East) (Con)]

My hon. Friend is making a fascinating case, because I, like many other Members of the House, I am sure, thought that this problem had largely been solved. Why does he think it is that the Government or the Department find it is so difficult to grip this? I recall having back surgery 35 years ago and being very grateful for some pain relief. I asked whether I could have some more, but I was told, “No, you can’t, because it is morphia. It is related to heroin and you might get addicted.” If it was possible properly to prescribe something related to heroin for a proper medical condition 35 years ago, why can something similar by way of the arrangements needed not be sorted out for this particular problem?

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[Crispin Blunt]

My right hon. Friend has alighted on a huge area of interest, which is pain control, not least end-of-life pain management. On the difference between opiate-based medicines, which he had, and cannabis-based medicines, the evidence is now all over the place about how much better the latter are, because people do not then have the addiction issues of the opiate-based medicines and they are not knocked out with what is, in effect, a chemical cosh towards the end of their life. They retain much better control of their faculties. They can enjoy a much better quality of life, even where they are being managed in terminal care, let alone where they are managing pain when they are not terminally ill. That is part of a missed opportunity. We are missing a huge bioscience opportunity for the United Kingdom because we have not got the regulations right, or their implementation has meant that these medicines have not begun to find the place they deserve in the pharmacopoeia and among the treatments available to doctors.

Of course, the private sector has stepped in where the NHS has not, and has used the special licence arrangements in the 2018 regulations, so we now have a two-track system. There have been three prescriptions on the NHS, but if someone has the means, they can pay roughly £2,000 a month for cannabis-based prescriptions. People can access cannabis-based medicines if they are prepared to go private and pay for it. That is an assault on the fundamental provisions of the national health service. Desperate parents of seriously ill epileptic children have moved countries to try to access this vital medicine. Of course, we will not know, because they will not tell us, how many have taken the illicit route and got their medicine from criminal sources. No parent or patient should face a prison sentence for treating a medical condition, and prioritising their health and the interests of those for whom they care and provide.

Access to healthcare in our country is, in principle, free at the point of use. Three years into the current system, that ought to be the case for medical cannabis as well. We should have made much more progress. The NHS’s own report on barriers to accessing cannabis-based medicine highlights the stark inequalities in, and problems with, the current regime. Although progress has been made on some preliminary fronts since the publication of that report, the most important outcome—appropriate, risk-based access to these medicines on the NHS—has simply not happened. We are being held back for a combination of reasons, including the risk aversion of a medical profession that is untutored and untaught in respect of the benefits—the endocannabinoid system does not appear in the syllabus for medical students—so the opportunity to have a cadre of doctors with the expertise to prescribe cannabis-based medicines now sits wholly in the private sector, and that expertise is available only at great expense.

This is not just about children with epilepsy, although they are of course the point of the spear, and everyone has huge empathy for them. Huge credit goes to End Our Pain, which got behind the Dingley family and put together the initial petition that got the issue into the public consciousness. That, combined with the Caldwell family, then got us formally over the line. I thought, as my right hon. Friend the Member for New Forest East (Dr Lewis) did, that this was done; but it was not. That is the tragedy: we have built up expectations. Out there in our constituencies, people have legitimate expectations that they can now get this medicine legally—that they do not have to criminally grow it or go to a drug dealer and get God knows what, because trading standards do not exactly apply to the supply of medicine that is criminally delivered.

Behind those children with epilepsy—our hearts go out to the families, and I give them huge credit for the effort they put into the campaign, along with the people from End Our Pain and the associated parliamentary group—there are tens of thousands of people with multiple sclerosis and chronic pain who could, by now, be benefiting from this medicine. The Government have gone to great lengths to try to address the issue of the epileptic children. I pay tribute to the Minister’s predecessor, my hon. Friend the Member for Bury St Edmunds (Jo Churchill), for all the time and passion that she put into engaging with this issue, meeting colleagues who represent epileptic children and getting into the detail of the prescribing barriers and the difficulty of moving cannabis-based medicines across international frontiers.

The Department of Health and Social Care also has to work through the Home Office regulations, which is not easy. If a Minister finds it difficult to enable medicines to be got to children who desperately need them, imagine how difficult it is for everybody else. I have huge confidence in the Minister, my hon. Friend the Member for Lewes (Maria Caulfield), who has empathy and understanding from her service as a nurse. She faces the challenge of having to grasp this complex issue.

The basis of the problem arose more than half a century ago. When cannabis was banned in the United States and then globally under the 1961 convention on drugs, it was put in the most restricted category of all for a reason that should shock and shame us: because 1950s American law enforcement thought that the principal users of cannabis were black Americans, so “It must be absolutely frightful. There can’t be any benefit in this.” Subsequently, cannabis found itself in schedule 1 of the Misuse of Drugs Regulations 2001, which made research almost impossibly expensive. That was utter madness, because the harms associated with cannabis-based medicines are fleeting and it is difficult to find evidence of them. That should be set alongside the potential benefits of treatments that ought to be available to people.

This research vacuum has meant that the Government are caught in a complex situation, and regulators are understandably highly risk-averse. We do not have the necessary skills, understanding or expertise among the medicine and health regulators who currently advise the Government. The medical and research community and the regulatory community are having to play catch-up because of the barriers that we politicians put in place in respect of a policy that has been around for more than 60 years.

Let me suggest to the Minister how we can move this issue forward, do our duty and serve UK citizens who find themselves in the wretched position of having to self-treat their conditions criminally because they cannot access the medicine otherwise. The public expect us to support them, and do not want sick individuals to be prosecuted for trying to obtain a medicine; that is where all registered public opinion sits.

My first suggestion is, of course, on funding for the epileptic children with the most serious conditions. There are so few of them, but the British Paediatric Neurology Association suggested that neurologists assess the parents’ finances before issuing a private prescription, lest they be unable to pay for treatment in future. Is that really the place where we want to be? It is inappropriate and impractical for doctors to make assessments of their patients’ financial circumstances because those patients have been driven into the private sector.

The issue has to do with the public stigma around the word “cannabis”, but that is utterly unrelated to any assessment of the evidence of risk. We have to take ourselves away from coming to a view having seen that word. That is no way for those of us to proceed who are charged with responsibility for legislating, for regulating, and for serving our citizens. If we put our reputation ahead of the evidence and what we ought to enable for our citizens, shame on us.

In the case of Orkambi for cystic fibrosis, my right hon. Friend the Member for West Suffolk (Matt Hancock) and his predecessor, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), were prepared to go the extra mile to find different routes to enabling the use of that drug through a managed access agreement. That shows that we can find creative solutions in this space if we are prepared to look for them. I urge the Government to return to this issue in a creative frame of mind to find a solution that will work.

Sitting behind this is the claim that we are a bioscience leader. Cannabis-based medicines should be part of that bioscience development. In the United Kingdom, another set of drugs—psychedelic-class drugs—suffer from similar problems. Some $6 billion has been invested in companies in north America to develop what is seen as the next leap forward in mental health treatment for addiction, trauma and depression. That sum is completely explicable if one considers the scale of those mental health conditions. If we are on the verge of enabling psychotherapy to work effectively for the people with the most difficult and challenging conditions, it is no wonder that the financial markets found $6 billion to invest in that—but by and large, they are not investing in it here, and this nation is a bioscience leader.

It is the experience of many prescribers of medical cannabis and their patients that medicines that contain additional cannabinoids—not just tetrahydrocannabinol and cannabidiol—are the most effective. As a result, children with treatment-resistant epilepsy are benefiting from prescription of those cannabis-based medicines, although largely privately. However, the manufacturers have struggled to respond to the calls for research from the National Institute for Health Research. The NIHR must engage with manufacturers more directly and, again, more imaginatively, and provide sufficient support and detail to help them through the regulatory minefield and over the regulatory barriers that are stopping the delivery of these medicines.

The fact that the research is so immature is a direct consequence of the blanket censorship of scientific inquiry around cannabis, because the attitude to it was formed, racistly, on the basis of who used it illegally. There was no regard to the evidence on cannabis. It is the same with the psychedelic class of medicines. There is very little evidence of risk, or of deaths arising from the misuse of these medicines in their pure form, and we have perhaps put mental health treatment back five decades by not investing in, and exploring, these medicines in the way that their risk deserved.

We must learn lessons from the way that the policy developed in the lead-up to the November 2018 regulations, which failed to deliver the reform and change that we seek in order to treat sick, epileptic children, and those with so many other conditions.

I offer my hon. Friend the Minister the solution, and I hope that she will take it up. I am conservative in the proper sense—in terms of machinery of Government changes, and in terms of uprooting public administration and then replanting it to solve a problem. However, we are in desperate need of an office for drug control to enable all the interested Departments to take counsel together in Government. When the business is led by the Home Office, we find that its job is to protect the nation and to stop things happening. It has certainly succeeded in that, as far as research is concerned. It is the former Home Secretary, now the Health and Social Care Secretary, who opened up progress on this. I have great hopes that we will push on with this when it is on the health agenda, as well as the science agenda, and the agendas of the Department for Business, Energy and Industrial Strategy and, given the amounts of money being invested, the Treasury. [Interruption.] I am not sure about the level of demand for this debate, Madam Deputy Speaker. I appreciate that everyone would like to get away as soon as they reasonably can.

I am passionate about this, because we can do some real good here. If we push forward with creating an office for drug control, we will bring together all the interests in making progress in this area—for example, the Department for Environment, Food and Rural Affairs with regard to the growing of hemp in the United Kingdom. One begins to see a picture of how some Departments that Carol Black did not mention in her review as engaging in the treatment of those suffering from drug misuse still ought to be involved in the whole drug policy conversation. Opportunities for treatment and for better healthcare are being missed, quite apart from the economic opportunities that should be available for the nation.

Mr Deputy Speaker, I know that you want me to bring my remarks to a close. NHS England and NHS Improvement were tasked in 2019 with designing clinical trials appropriate for children who, in many cases, have made significant improvements and cannot ethically have their treatment withdrawn as would be required in a standard randomised control trial. We can and we must be flexible. The urgency of enabling timely access to medicines for these children was made clear, but it has not happened. These trials must happen and must present a route to access.

Sitting behind that are children who naturally tug at our heartstrings, given their conditions and the extraordinary cornucopia of steroid treatment and everything else that has been thrown at them. They deserve our sympathy. Behind them sit tens, hundreds and possibly millions of our fellow citizens who can also benefit if we get the bioscience, the research and the regulatory framework right. I look forward to conversations with my hon. Friend the Minister as we go forward. I recognise her need and that of her fellow Ministers in the Health and Social Care Department to make sure that the advice of the regulatory agencies that advise them is properly taken. In the first instance, though, those regulatory agencies require the right expertise, knowledge and understanding, and they need to acquire it in order to give her and her colleagues the right advice.

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[Christine Jardine (Edinburgh West) (LD)]

It is a pleasure to follow the hon. Member for Manchester, Withington (Jeff Smith). I thank the hon. Member for Inverclyde (Ronnie Cowan) for securing this debate on medicinal cannabis.

I am sure I am not alone in this place in often being asked by people, “What is it that makes you want to be an MP?, “What is it about being an MP that is rewarding?”, or, particularly after days like yesterday, “Is it not frustrating?” When I am asked that, I point them to what happened a couple of years ago, when my constituent Karen Gray came to my office with her wee boy Murray, who, up until that point, had been the subject of lots of conversation and lots of letters back and forward to the Scottish Health Minister and to the then Health Secretary about the availability of cannabis oil. She brought him into the office and he sat and explained to me all about why he liked dinosaurs. That might seem unremarkable. But before then—before he had cannabis oil—Murray was likely to have up to 100 seizures in a day. He had spent much of his life in hospital and missed much of his education, and his parents were worried for his future.

Three years ago, when the then Home Secretary, now Health Secretary, made cannabis oil legal, it gave Murray’s family hope that their lives would change, and their lives have changed, Murray’s life most significantly. But it still is not fixed, because now the specialist who was prescribing cannabis oil for Murray has retired. When they did, earlier this year, they wrote to the Secretary of State asking what was to happen, because there would now be only one clinician in the country prescribing cannabis oil for hundreds of children for whom Epidiolex is not appropriate but for whom cannabis oil does change their lives and keep them safe. I have spoken to Murray’s mum about this. She is of the opinion—and says that the specialist was as well—that many GPs and doctors in this country want to be able to help their patients with cannabis oil, and that will be possible only if the Department of Health changes its policy and encourages the profession to do so.

This is the third debate on this subject that I have taken part in in the past couple of months. Each of them was secured by an MP from a different party. Today’s debate was secured by the hon. Member for Inverclyde, who is a Scottish National party Member. Yesterday’s debate in Westminster Hall was secured by a Conservative Member. I secured the other debate, as a Liberal Democrat Member, and we had support from Labour Members. I am at a loss as to how an issue that is so emotive, and has so much support across this House and across this country, has to keep coming back. We have to keep asking the same questions. We have to keep saying that clinical trials will not work because cannabis oil is not suitable for clinical trials. Even the NHS has said so. In its report of 8 August 2019, it recommended that there should be alternative trials. By that I assume it means observational trials.

I wonder what motivated the Government and the then Home Secretary to change the law: I suspect that he wanted to do it in the best interests of a child, and children, who were suffering and could be helped by that change in the law. I also wonder how frustrated he, and other politicians who took part in that decision, including all of us who worked hard and campaigned for it, must now be that despite that significant—in some terms, massive—change by this Government, we have not made the intended progress. People are still in pain in this country. Families are spending, as we have heard, upwards of £1,000, sometimes £3,000, a month to secure legal medication for their children that they cannot get on the national health service—the national health service of which we are so proud and that is supposed to deliver free-at-point-of-delivery care from cradle to grave.

[Crispin Blunt]

A few of us have constituents with a child with epilepsy and have invested the time to get a detailed understanding of many of the issues. The problem, as alluded to by my right hon. Friend the Member for New Forest East (Dr Lewis), is that most of our colleagues think we have done it. After the decision was taken in November 2018—or when the licence was given for Billy Caldwell to get his medicine—the conclusion was that one would not be able to find anyone who was objecting, because if one can have medicine from the Asian poppy, why on earth can one not have medicine from cannabis? There was probably no opposition in this place at all. But the tragedy is that the evidence is that we have not done it. We must get back into the complexity. We will support the new Minister in fighting her corner to ensure that people can get these medicines, along with all the other interests that are engaged here too.

[Christine Jardine]

I thank the hon. Member for his intervention. He is absolutely right; I could not agree more. We all thought it was done, but more importantly, and more upsettingly, so did the families of the hundreds of children, and adults, who would benefit—adults with conditions such as multiple sclerosis for whom it would be life-changing. They all thought it had been done and cannot understand why it is not. I have to be honest: I cannot understand why it is not either, and why it simply cannot be done. Will the Government please consider using observational trials instead of insisting on clinical trials, which are not appropriate?

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[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I congratulate the hon. Member for Inverclyde (Ronnie Cowan) on bringing forward this debate. As has been said, this is the second day in a row that we are debating this important issue, and I appreciate the depth of feeling on it. I know there are many Members who wished to speak today but who have not been able to, including the hon. Member for Gower (Tonia Antoniazzi) and my hon. Friends the Members for Dover (Mrs Elphicke)—Teagan Appleby is her constituent—and for South Derbyshire (Mrs Wheeler).

As I said yesterday, I have huge sympathy for the issues, problems and struggles that patients and their families are facing. They are trying desperately to access these drugs. No one wants a resolution to this more than me and the Secretary of State, who, as has had been said a number of times, changed the law when he was Home Secretary to try to resolve this situation.

Yesterday, I confirmed the Government’s absolute commitment to take an evidence-based approach to unlicensed cannabis-based products for medicinal use in order to ensure that there is evidence that they are effective but also safe. A number of colleagues have asked why the Government cannot accept non-randomised controlled trials as evidence. The Government are not involved in the process of licensing the medicines; that is done by the independent regulator. The Government’s responsibility is in changing the law, which has already been done, but I very much take the point that we should be able to influence the speed at which the licensing process can take place. I will point out in my remarks how we are doing that.

I am willing to work with colleagues across the House, whether that is the hon. Member for Manchester, Withington (Jeff Smith), with his private Member’s Bill, or SNP Members. This is a non-political issue that we want to see resolved, but the Government are not the body responsible for licensing medication or assessing the worthiness of the research, whether that is randomised controlled trials or any other form of evidence.

Before I set out what is being done, I want to provide an update on the matter of Bedrocan, because the hon. Member for North Tyneside (Mary Glindon), my hon. Friend the Member for Reigate (Crispin Blunt) and the hon. Member for Inverclyde all mentioned it. The commercial agreement between Transvaal Apotheek and UK specialist medicines manufacturer Target Healthcare is progressing, and the MHRA and the Home Office are working with those companies to ensure that all regulatory standards for manufacturing these medicines are met.

On 16 September, the Home Office granted a six-month licence, which will allow Target to move on to testing its equipment and procedures using cannabis from the Netherlands and validating their production of Bedrocan oils. Departmental officials continue to work closely with the Dutch Government, Transvaal, the Home Office and the MHRA to ensure continuity of supply until domestic production can be established, and I will keep the House updated on progress. I hope that is a little glimmer of hope on that issue.

I am aware that there is huge patient demand for access to medical cannabis, and that many are convinced it is helping them with an array of medical conditions from chronic pain to cancer. To date, however, much of the evidence suggesting cannabis could be effective as a treatment is anecdotal. While that has some strength in observational studies, from the regulator’s point of view it often needs more robust clinical data.

There are two licensed cannabis-based products and one synthetic cannabinoid that mimics the effects of THC, which is the element I think most campaigners are looking for. We do have Sativex to treat severe spasticity in adults with multiple sclerosis, Epidyolex for the treatment of two rare forms of epilepsy and Nabilone for nausea and vomiting, so we are making some progress. I hear from campaigners that the THC element remains outstanding. Those products that are licensed are proof that when manufacturers invest in clinical trials, the potential of cannabis as a medicine can be realised. Clinical trials generate the data needed by our world-leading medicines regulator, the Medicines and Healthcare products Regulatory Agency, to assess for safety, and it is then for NICE to approve the NHS funding element of that.

Let me reiterate that this is a multiple-step process. Orkambi has been mentioned; the issue with that was not licensing—it had a licence—but NHS funding. If we get to the licensing stage, the Government can do a huge amount more to fast-track things and be involved in discussions. Licensing, however, is an independent process, and that is the point at which we are stuck.

[Crispin Blunt]

I used that parallel as an example. I totally respect my hon. Friend’s point about licensing progress—of course she is correct—but this is about thinking imaginatively to work our way through the problems to the right solution. That applies desperately in this situation, as it did with Orkambi.

[Maria Caulfield]

Absolutely. The Government are committed to trying to resolve the blockage to licensing, which is the main factor hindering the prescription of these drugs. The Health and Social Care Secretary changed the law when he was Home Secretary, but that was not the end of the issue, and that is why we are taking these next steps. It is important not to dismiss the importance of licensed medication. We know from history that when medication that may have a good clinical effect is not tested thoroughly, there can be grave consequences, just as with thalidomide. The safety of a medicine is as important as its efficacy. I am not casting aspersions on cannabis, but the regulator has responsibility for all medicines, and it takes that issue very seriously.

Dame Carol Black’s Independent Review of Drugs Report

Crispin Blunt Excerpts

Wednesday 27th October 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I congratulate the hon. Member for Liverpool, Walton (Dan Carden) on securing this extremely important debate. I pay tribute to all his work on addiction and his openness regarding his personal experience in previous debates. As the right hon. Member for Leicester South (Jonathan Ashworth) said, he brought many of us to tears. No doubt his example will serve as inspiration for others to take that crucial first step of coming forward to ask for help.

I thank all those working in the drug and alcohol addiction sector, particularly during the pandemic. I commend the work they do to help people through periods of their lives that are exceptionally difficult, often through no fault of their own. As the hon. Gentleman highlighted, the drug and alcohol addiction sector faces challenges. There is no hiding from it. Drug misuse deaths in England have been on the rise for many years and are currently the highest on record. That is true across most of the United Kingdom. Our neighbours are all grappling with this devastating issue, particularly Scotland, where deaths rates are the highest in Europe, as hon. Members have highlighted.

Drugs destroy lives, ruin families and tear apart communities. That is why in February 2019 the Home Secretary appointed Dame Carol Black to undertake an independent review of drugs. Part one was published on 27 February 2020, during the Government’s UK-wide drugs summit in Glasgow. It provided a detailed analysis of the challenges posed by drug supply and demand, including the first detailed analysis of the drugs market and the ways drugs fuel serious violence. After being commissioned by the Health Secretary, part two of Dame Carol Black’s independent review of drugs was published earlier this year, on 8 July. As hon. Members have highlighted, Dame Carol made it clear that tackling drug addiction needs to be more health focused. I am committed to making it so. I agree with the hon. Gentleman that now is the moment for change.

I would like to talk about the substantial action the Government have already taken and our commitment to go much further. Dame Carol has been a fantastic champion for better treatment and recovery services. I am very pleased she will be working closely with the Government as an independent advisor, holding us to account each step of the way and providing advice on how we can make real change. We are already making improvements to treatment and recovery through the £148 million crime package announced in January this year. Of that, £80 million has been allocated to local authorities for drug treatment and recovery services. This is the largest increase in drug treatment funding for 15 years, and it is already making a difference.

That funding allocation is being focused on increasing the number of treatment places for drug users in contact with the criminal justice system, diverting people away from custody and into treatment services and, crucially, making sure that we get more people into treatment after they are released from prison. It is also being used to fund additional in-patient detox beds, further residential rehabilitation places and the life-saving overdose medication naloxone. The additional treatment places are most needed, and they will benefit people with alcohol dependency as well as drug dependency.

The Government published our initial response to the findings of part one and part two of Dame Carol’s independent review on drugs on 27 July 2021. The response did not hold back in setting out our clear cross-Government commitment to this agenda and to taking effective action, given the urgency of addressing these issues. We committed to responding to Dame Carol’s review in full by the end of this year, and to set out a long-term drug strategy. That is exactly what we will do. I would like to reassure hon. Members that Dame Carol’s review will definitely not sit on the shelf.

As Dame Carol points out, we must work across the whole of Government to combat drug misuse and drive down drug supply and demand. That approach is absolutely key. That is why, in July this year, we established a new joint combating drugs unit, whose mission is to co-ordinate and drive a genuinely whole-of-Government approach to drug policy. The joint unit is already bringing together multiple Government Departments to tackle the problem across society. I am pleased that a number of staff from my Department have joined the unit, again ensuring that there is a health focus and that health lies at the heart of analysis and decision making.

[Crispin Blunt (Reigate) (Con)]

I want the Minister to take up the offer to work together made by the Opposition spokesman, the right hon. Member for Leicester South (Jonathan Ashworth), and to work with colleagues such as me who take a specialist interest in this area. This should not be used as a political football in any circumstances. The crisis is too great and all of us stand ready to try to help her and her colleagues to deliver improvement in this area.

[Maggie Throup]

I thank my hon. Friend for that intervention. He is right that this is too important an issue to become partisan over, and I completely accept the offer from the Opposition spokesman of joint working on this. We are all passionate about this important issue and we need to make sure that we get this right for individuals who can really benefit.

I thank the hon. Member for Liverpool, Walton for securing a debate on such an important issue. This Government are absolutely committed to ensuring that everyone with a drug problem can access the help and support that they need. He stated that support must always be compassionate and person-centred, and the hon. Member for York Central (Rachael Maskell) highlighted that the way forward is to have an individual-centred approach. We cannot have a one-size-fits-all approach. Our long-term plan will be set out in detail in our cross-Government drugs strategy, which will be published later this year.

We understand that there is still a lot of work to do. There are also huge challenges across the drug and alcohol sector. This cannot be fixed overnight and we cannot do it without the help of every single local authority in the country, as well as through truly collaborative cross-Government and cross-party work involving the NHS. As a number of hon. Members have mentioned, the voluntary sector plays an important part, too. I put on record my thanks to everybody who is making a huge difference, whether that is at a statutory or a voluntary level, to so many people’s lives and to their futures. I genuinely believe that by working together, we can make a huge difference, and I look forward to that in the future.

Oral Answers to Questions

Crispin Blunt Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

The hon. Gentleman is right to raise this issue. Whether it is for treatment for cancer or other illnesses, we do need more clinicians in the NHS. On meeting the ongoing demand, I was pleased to see that this year we had the highest number of students ever entering medical schools for general practice, for example, and across the board. He may be interested to know that, for the year to date, to June 2021, the NHS has 2,700 more doctors and 8,900 more nurses. There is more to do, and I am pleased that he raised this issue.

[Crispin Blunt (Reigate) (Con)]

T7. [R] My right hon. Friend will be aware of the potential emerging treatment of the most difficult mental health conditions, including depression, trauma and addiction, if psychotherapy were reinforced by pharmacology with appropriate use of the psychedelic class of drugs, including psilocybin. That could benefit millions of our fellow citizens, including more than 2,000 of our veterans wrestling with untreated trauma from their service in Iraq and Afghanistan. Today, it is very difficult to conduct research in the UK due to the scheduling of those drugs in the most restrictive category of all, with absolutely no evidence of risk to support that immense burden placed on science and medical research. Every day we delay this science, scores of our fellow citizens will die unnecessarily, and millions will suffer unnecessarily. Will my right hon. Friend urgently examine this issue so that British people receive British scientific research and British pharmaceutical—

[Mr Speaker]

Order. Come on, Secretary of State or Minister—whoever is answering. We have to get through these questions or it is unfair to others.

Medicinal Cannabis

Crispin Blunt Excerpts

Monday 6th September 2021 Commons Chamber

[Crispin Blunt (Reigate) (Con)]

I congratulate the hon. Member for Edinburgh West (Christine Jardine) on securing the debate and on her brilliant timing in doing so on an evening where we can debate not only the narrow issue being focused on by the wonderful campaign End Our Pain—the plight of these epileptic children. I do not have one of those children in my constituency, but a number of us do, and by goodness, if I did, I absolutely would be championing their cause. However, this discussion also needs to take place in the context of the whole debate about medicine and how we need to improve our nation’s and people’s access to medicines that work.

My right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) was behind me on the day that I asked the urgent question that followed the march and the petition that we presented to Downing Street. It was when he leaned over to me in the Chamber and said, “We don’t agree about very much, Crispin, but I support you on this,” that I realised that what I would have regarded as the Taliban, as far as drugs policy was concerned, had come on side. With enthusiasm, we embraced my right hon. Friend’s help because of his influence with the Prime Minister. Having worked with him, I will not disguise the fact that we come from a very different place on wider drugs policy; he managed to get me a splash in The Sun when he was taking the Psychoactive Substances Bill through the House, which was my moment of notoriety in the Chamber. However, the context of what we are considering today is a drugs policy in the United Kingdom that is nothing short of catastrophic.

We need to work towards creating institutions that can advise the Government with evidence, authority and expertise. The truth is that we have proceeded with drugs policy for more than five decades on the basis not of evidence, but of reputation and what people think—exactly what my right hon. Friend was saying about the implications of the word “cannabis” and what people adduce to it. We have not proceeded on the evidence.

[Paul Girvan (South Antrim) (DUP)]

I thank the hon. Member for making that point, because if we were to adopt the same approach with opiates, we would be giving people “heroin” as pain relief: we call it morphine, but it is heroin by another name. If we continue to talk about medicinal “cannabis”, stigma will continue to attach to the part that gives a hallucinogenic effect. That is the part that everyone will focus on unless we start to change the direction, the language and the naming, which is why the medical profession is blackballing it on every occasion.

[Crispin Blunt]

The hon. Gentleman has landed on the core of the problem: the reputational issues that we are dealing with.

We owe it to our constituents to do just a little better. We owe it to them to try to understand the evidence and create institutions that will advise our Government based on the evidence. We have a duty not to be stampeded by the popular press in a particular direction about the particular meanings of words, but we have done so for 50 years in regard to cannabis: it was shoved in schedule 1 to the regulations made under the 1971 Act, which governed the most dangerous narcotics, and we kissed goodbye to 50 years of understanding within the medical research sector of what might be possible.

We were then left with the situation that we faced in 2017: after my two and a half years’ experience as prisons Minister, the evidence was plain throughout the entire justice system, as it is today, that our wider drugs policy is an unqualified disaster. We have watched the frog in the pot as the temperature has risen and risen over five decades; it is now boiling over and shreds are coming off. We have the worst drugs death rate in Europe and our drugs policy has dominance over the criminal justice system, driving half of acquisitive crime in the UK. Those issues elide into the narrow issue of medicine from cannabis, but we owe it to our constituents to understand the context.

I say this to the Minister particularly: if we can get the change of approach right, there is a huge opportunity. It is not just about the magnificent campaign by End Our Pain and my right hon. Friend the Member for Hemel Hempstead for the 17 identified epileptic children and their families, although of course there are duties that we all owe to them, and they raise the question of what we would do in their position. I was in the Chamber when my right hon. Friend said that he and Frank Field would be at customs to deliver the bottles of medicine—and an absolutely splendid occasion it was, too.

It is not just about epileptic children; it is also about people with multiple sclerosis. An estimated 50,000 people in this country are growing their own medicine, at peril of a 14-year prison sentence, all to try to make themselves better. From those 50,000, there is a huge amount of research evidence, all of which is lost to the legal system: people are growing particular plants and adjusting the exact balance of the cannabis product that they produce to best use for their condition.

[Adam Afriyie]

My hon. Friend is making a powerful speech. I have chaired the Parliamentary Office of Science and Technology, and it seems to me that medicines generally arise because of people’s behaviour beforehand. People were chewing bark because they felt that it relieved pain, and now we have aspirin. I think that much of the development of medicines—very precise and targeted medicines—comes from the experience of people and what they do themselves. As my hon. Friend says, there is a body of evidence, and it is a matter of collating that evidence, but it is also a matter of the people who adopt these methods at an early stage taking on a risk for themselves, and we should use the information and evidence that we gain from that to build on the scientific knowledge that we have.

[Crispin Blunt]

I was delighted to take that intervention from my hon. Friend. He is absolutely right: this is about science and technology. It is about finding a route to a Government who can deliver policy based on evidence. We have heard very clearly why randomised controlled trials and placebos are not going to work in this case and are a completely inappropriate way of providing proof, and that there is a vast amount of observed evidence out there. What we need to do is understand the context. The case is unanswerable for these epileptic children—of course it is, and of course their treatment should be should be paid for privately if it cannot be provided by the NHS because all these barriers have appeared—but behind them sit a vast number of other people who are not being served by our system of developing drugs that will work for their conditions.

[Tonia Antoniazzi]

The hon. Gentleman has made some very valid points about the wider issue of drug reform, and I agree with much of what he has said. As he well knows, when I first came to the House the late Paul Flynn, then Member of Parliament for Newport West, was a doughty campaigner for medicinal cannabis. I had many conversations with him about it, and much account was taken of what he said. He advanced valid arguments about people with multiple sclerosis, many of whom were our constituents, and I believe that the hon. Gentleman too has a genuine argument in that regard. Tonight, however, we are focusing on the cost of medicinal cannabis to end the pain of epileptic children, and our real ask of the Government is a fund to provide them with money immediately, although we will work together on the wider debate.

[Crispin Blunt]

I wholly agree with the hon. Lady, whose leadership of the all-party parliamentary group on access to medical cannabis under prescription, along with that of my right hon. Friend the Member for Hemel Hempstead, adds to the whole discussion and illuminates the fact that our drugs policy is in a serious state of strife. It is not based on evidence, and we have to drag it in that direction. Behind the hon. Lady sits my friend the hon. Member for Manchester, Withington (Jeff Smith), with whom I have the honour of co-chairing the all-party parliamentary group for drug policy reform. We took over from the hon. Member for Brighton, Pavilion (Caroline Lucas) and from Paul Flynn. My objective, as the first Conservative to take his place, was to drag this conversation into the mainstream, which is where it belongs.

However, we need to remember just what got this over the line in the first place. The Dingley family behaved perfectly within the rules. They made applications and everything else, and indeed we had an urgent question on the subject. I remember my right hon. Friend the Member for Hemel Hempstead interrogating the then Policing Minister, who had taken on the responsibility, about when this was going to happen, particularly for Billy Caldwell.

What got this over the line, however, was the fact that Bill Caldwell’s mum, Charlotte, was brave enough to obtain the medicine in north America, present it to customs and have it confiscated. Her son was then hospitalised and was fitting, and within three days the overseeing consultant was on the steps of the hospital saying, “I do not care about what is going on here; it is unbelievably cruel to take a medicine that works away from a child.” The following day, the then Home Secretary—now, wonderfully, the Health and Social Care Secretary: what a brilliant repositioning that is—authorised the return of Billy’s medicine, or at least some of it, from customs so that he could receive his treatment.

[Sir Mike Penning]

While we are name-checking colleagues, we should mention one chap who is not here because he has left the House, and that is Frank Field. My hon. Friend referred to Frank—[Interruption.] Oh, he is in the other House now, is he? Lucky fella! Frank and I were absolutely adamant that the following day, we were going to go to Holland and come back, and that unless a change to the legislation had been indicated the following day, we would be arrested. But what a great reason to be arrested, trying to save someone’s life! It was Frank’s idea, and I jumped on with him—we should also acknowledge other people including Billy Caldwell’s family and Alfie’s family; I completely agree with that—but without Frank jumping in as well, we would really have struggled.

[Crispin Blunt]

This is where we come to the cost, to which the hon. Member for Gower (Tonia Antoniazzi) drew my attention. In order to get Alfie Dingley’s prescription over the line, it would have taken £5,000 for the person who was going to make the application, who happened to be on holiday in the Galapagos Islands and who then had to be interviewed by Home Office officials before he was allowed to make the application; £5,000 for the pharmacy to get a licence to bring it in; £5,000 for the pharmacy then to hand it out to the doctor; and then £5,000 for the licence for the prescribing doctor. I mean, I ask you! It might have been possible to pay in that case, but behind the case of Alfie Dingley, there is not just a score of epileptic children.

[Tonia Antoniazzi]

On that point, I made two journeys to The Hague with families—out of my own pocket, which was absolutely fine; it was not funded by anybody—because they needed the support to go over and get those medicines. They do not have the extra money and they do not have the time, which is why we stand by them and why we have to help them.

[Crispin Blunt]

The hon. Lady has behaved as the best of constituency MPs would. Indeed, I am sure that all of us, faced with the opportunity to help people in that way, would want to do so.

I say to my hon. Friend the Minister that, despite the legalisation in November 2018, the system remains broken. It remains broken in respect not only of cannabis but of the psychedelics. A wave of interest came into medicine as a result of cannabis; it came from North America where a significant amount of investor money was going into the new industry because people could see the opportunities that were available there. However, we could not do the research here because it was a schedule 1 drug, and hardly any universities had a schedule 1 licence to do that research. The level of oversight was far greater than that for heroin, as the hon. Member for South Antrim (Paul Girvan) said, so it is no wonder that there has been almost no research on all this down the decades.

As far as I can see from the 1960s, the psychedelics got shoved into that group as well because pop stars used them. Then, in 2008, we managed to dismiss the chairman of the Advisory Committee on the Misuse of Drugs because he had the presumption to say that riding a horse was a damn sight more dangerous than MDMA. That is what we do to the scientists who produce the evidence: we refuse to listen to the evidence because it will be politically inconvenient and subject to misrepresentation in the media. We owe our constituents way more than that, and it would be remiss of us if we do not examine this whole area on the evidence. I implore my hon. Friend the Minister to listen to it.

I have spoken about MS, and the hon. Member for South Antrim and others have referred to pain relief. As an alternative to opiate-based medicines, given all the difficulties of the opiate crisis in the United States, cannabis-based medicines offer a serious group of advantages if they can be deployed properly. Meanwhile the psychedelics still sit in schedule 1, making research incredibly difficult and expensive.

Let us consider depression, addiction and trauma. Of the veterans who have come back from their service in Afghanistan and Iraq in recent years, 7,500 have post-traumatic stress disorder, about a third of whom are beyond treatment within the current treatments available. However, the evidence is that the prescribed and overseen use of psychedelics can get to the relevant part of the brain and enable the psychotherapy to take hold and teach people to acquire the tools with which to manage and deal with their trauma. That can also work for depression and addiction. We are potentially talking about millions of people, if we enable the research to happen. Are we a country that will be on the frontline of bioscience? Are we serious? There is an opportunity for our pharmaceutical industry to get this to scale, and millions of people can be helped.

A huge cost is currently imposed on our economy by these medical conditions, so surely it makes sense to enable my hon. Friend the Under-Secretary of State for Health and Social Care, as Minister for medicines, to draw on evidence-based advice. Sitting alongside the MHRA ought to be some kind of cannabis authority, as has been done in Denmark, Holland and Germany, for Ministers to get the advice they need to be able to advance policy confidently, and it needs to be within a wider office for drug control that engages all the relevant Departments. A Department of Health and Social Care lead would be good, but a Cabinet Office lead that brings together everyone who has an interest in this area would be a fine thing, too.

[Adam Afriyie]

I thank my hon. Friend for giving way, although I do not entirely agree with all his views on the legalisation of drugs. I was shadow Minister for Science back in the day when Professor Nutt was forced to resign for making comments that were factually accurate, and the House is now very different. I feel quite optimistic today, like the hon. Member for Edinburgh West (Christine Jardine), because I sense the mood of the Chamber and the Secretary of State for Health and Social Care. If there were some mechanism to bring in the clearly available research on people who have already been using these refined substances, I think the Government and this House are in the mood to take those views on board.

[Crispin Blunt]

I largely agree with my hon. Friend, apart from on the views he imputed to me. He decided what my views are on the legalisation of drugs, but I simply want policy based on evidence.

All I will say is that the current situation is a catastrophe, not just here but around the world. It is the basic reason why we were run out of Helmand province. The farmers around Didcot were growing poppies for the legal medical morphine market, but we did not allow the farmers in Helmand to grow poppies, so they were driven into the heroin market. We then decided to go and burn their crops, reducing them to penury. And we wonder why they changed sides and were against us. We were run out of Helmand, even with 20,000 American troops coming to the aid of our soldiers.

This issue permeates the world. It is a global issue. We simply need to proceed on the basis of the evidence, so we need to create the institutions that can give us that evidence. There should be an office for drug control, promoting all the science and bioscience of which this country should be capable, within which ought to be a cannabis authority of some kind that could give the Minister and her colleagues the advice they need. The opportunity for the Department of Health and Social Care is huge, and the opportunity for the Department for Business, Energy and Industrial Strategy in sponsoring our science is enormous. The opportunity for the Treasury is not exactly minuscule either, and there is an opportunity for the Home Office to have a policy that contributes to the whole of the public interest, not just a very narrow part of it that has done so much damage. The policy of preventing things from happening has been in the lead in the drugs policy area, so this proposal is long overdue.

I beg the Minister to have this discussion with me and the think-tank I have established. I have no financial interest to declare, as I take nothing from the Conservative Drug Policy Reform Group. I set it up to give me research and scientific evidence on which to help advance these arguments. I am passionate about this issue, and it is one of the issues on which I wish to use my remaining time in public life. Having seen what I have seen as Prisons Minister and in my own experience, I know the opportunities are as great as the opportunity to end the terrible mess of our wider drugs policy. If we can grasp the science opportunity, the medical opportunity follows. There would be a huge advantage for patients in the United Kingdom.

[Tonia Antoniazzi]

The work the hon. Gentleman does with his think-tank is brilliant. How much would this cost? How much does he think the Government need to put aside—we are talking about the cost of medicinal cannabis—to reform policy? Are there any figures? Are there any plans to put that in place?

[Crispin Blunt]

The machinery of government changes can be made at very little cost. This is about getting the right advisers and the machinery of government advice. Obviously, we would then have to recruit the people into the cannabis authority who understand the issue, and allow them the authority and space to be able to advise Ministers and the office of drug control. However, the up-front cost would be minimal. The opportunities and the number of people we can really help by having far better drug provision in the UK are huge. All of us have a duty to engage properly with that and to be able to disaggregate all the issues and negative connotations associated with the use of cannabis and heroin. Let us focus on the evidence and get this conversation into the mainstream as a means by which we can make huge advances for our country. I look forward to the ongoing conversations with the Minister, who as the Minister for medicine could make a huge impact if she were able to deliver on this part of her agenda.

--- Later in debate ---

[Jo Churchill]

I will focus on the end bit. We do need to give clinicians comfort if they are going to prescribe medicines that help alleviate children’s pain. The challenge with the observational trial, as anyone who has been involved with medical trials will tell you, is that the smaller the cohort, very often the greater the problem is with the confidence intervals, and so on and so forth. There is a need to look at things by perhaps turning the telescope the other way up to see whether we can focus ourselves on approaching this in a different way to find solutions. However, the bottom line is that we need good evidence, because we have also been in this Chamber talking about drugs where the challenge to the patient has then transpired, and we later we have been here talking about the damage.

[Crispin Blunt]

Particularly in the light of what my hon. Friend has just said about turning the telescope around and thinking about this in a different way, this is not just about the United Kingdom; this is global. There is evidence all over the world that we can use, and we do have a terrible tendency of “not invented here” in some of this. There are other countries in which the authorities are finding a positive way to license this medicine. While obviously the focus is on these particular children now, behind them sit tens of thousands of people self-medicating on cannabis and making themselves criminals in the process. Behind them sit our 2,500 veterans who have untreatable trauma, who are being driven into the hands of dealers to find ways of managing that trauma. We are turning heroes into junkies because we are not advancing the science base as fast as we should.

We should be really supporting the research, which is why I am delighted to hear what my hon. Friend has just said. Let us really go for this. We can underpin the bioscience base of our country if we do so. We have just seen Dr Carhart-Harris, a leading researcher in the whole application of psychedelics, disappear from doing research in London to the United States. It is exactly the parallel argument with medicine from cannabis. We need to get behind the scientists and the researchers, and let them help our people and teach our medical profession what is available to them to help their patients.

[Jo Churchill]

That is true. However, people have to come forward with clinical trials designed in a way that is acceptable and gives us robust outcomes. We have discussed this and Psilocybin, and many other things, at some length in the past, and although tonight is not the time to carry that on I am sure we will do so again.

We take into account literature and evidence from other countries, and the guidelines published by the National Institute for Health and Care Excellence were developed in accordance with well-established processes based on internationally recognised and accepted standards. This ensures a systematic, transparent approach in identifying the best available international evidence within the scope of guidance at the time of the NICE evidence review. However, NICE found that current research is limited and of low quality, and that makes it difficult to assess just how effective these medicines are, and we need to make sure they are safe.

Coronavirus Regulations: Assisted Deaths Abroad

Crispin Blunt Excerpts

Thursday 5th November 2020 Commons Chamber

[Matt Hancock]

I agree with my hon. Friend that the question should be located within that broader debate. I understand the yearning from people not to shorten life, but to shorten a painful death. Of course, no specific proposal has been brought forward; that would be for Parliament to develop rather than the Government.

[Crispin Blunt (Reigate) (Con) [V]]

Does my right hon. Friend agree that at the heart of the issue is properly established personal autonomy over the time and manner of someone’s death when they are terminally ill? The safeguards around that have been operating for more than two decades in other parts of the world, as I saw on a visit to Oregon 20 years ago. He is right that this must be led by Parliament, but the evidence is developing all the time and the Government will have to make time for the debates and opportunities to assess that evidence. Parliamentarians should proceed on the basis of the evidence available to them, because if they choose to impose faith-based views on others, it can result in the most terrible cruelty.

[Matt Hancock]

We would consider collecting more data on these questions, because it is important that any debate is conducted based on the evidence, but it is also important that the debate takes into account all views that are sincerely held and very reasonable.

Lesbian, Bisexual and Trans Women’s Health Inequalities

Crispin Blunt Excerpts

Tuesday 10th March 2020 Commons Chamber

[Crispin Blunt (Reigate) (Con)]

May I start by congratulating the hon. Member for Livingston (Hannah Bardell) on securing this debate? I am very pleased, as chair of the all-party parliamentary group on global LGBT+ rights, to support her wholeheartedly. She has made some excellent points. Obviously, her personal testimony is immensely powerful, and her points about the trans issue were extremely well made. I had immediate sympathy with her comments on coming out with political privilege, which describes my own coming out in 2010.

The APPG on global LGBT+ rights is, at present, the only APPG organised in support of such rights. It focuses on global LGBT rights, where the position is very different from that in the United Kingdom. I thank the group’s administrator, Anna Robinson, for her help and the briefing she has afforded colleagues and me for this debate.

I also thank the Backbench Business Committee for allocating time in the Chamber to debate this important subject. This is the first time that lesbian, bisexual and trans women’s health inequalities have received a dedicated debate in this House. The issue was debated in the other place in 2014. This debate is timely because it is National Lesbian, Bisexual and Trans Women’s Health Week. The importance of what began as a civil society initiative was acknowledged in the Chamber last year by the then Minister for Women and Equalities, my right hon. Friend the Member for Portsmouth North (Penny Mordaunt), who I am delighted to see in her place.

Let me try to put this issue in its context in the United Kingdom. This debate is taking place in a Parliament that has more out LGBT MPs than any other. This Parliament, over the past two decades, has gone from equalising the age of consent—which took it five years; I think we were both special advisers when the process began, Madam Deputy Speaker—and being coerced by the European Court of Human Rights to allow LGBT people to serve in the armed forces, to delivering adoption rights, civil partnerships and, finally, equal marriage. All those measures were taken with increasing enthusiasm by Parliament. The legal case for equality in the United Kingdom has been made. I think we can be proud of Parliament’s leadership today in what a former Father of the House, the late Sir Peter Tapsell, who was elected in 1959, rightly described as the most profound social change of his lifetime.

The change has been very profound in my party. Sir Alan Duncan was the first Conservative MP to come out in 2002. Nick Herbert was the first successful out Conservative to be selected in 2005. Yet just 15 years later, the Conservative party now has the largest caucus of out LGBT MPs in Parliament. That change is perhaps reflected in the sensitivity and the priority the Government have given the issue since 2010. It is reflected in the really excellent “LGBT Action Plan 2018”, authored by my right hon. Friend the Member for Portsmouth North, and a year later, the follow-up report. I have not heard it challenged that that is the most comprehensive plan of its kind in the world, and that sets the context for today’s debate.

We have delivered equality in law, but we now need to deliver equality in outcome. Unequal health outcomes are perhaps the most concerning of all. We know that LGBT+ people of all genders still face inequalities when it comes to access to and the provision of health services. Last year, the Women and Equalities Committee, chaired by my right hon. Friend the Member for Basingstoke (Mrs Miller), produced a groundbreaking report on health and social care and LGBT communities, which showed that unacceptable inequalities remain in the provision of health and social care services when it comes to the LGBT community. The report identified that deep inequalities exist in health outcomes for LGBT communities; that LGBT people are expected to fit into health systems that assume they are not LGBT, which has a significant impact on LGBT people’s ability to access the services they require; and while the LGBT community does generally have the same health and social care needs as the rest of the population for the majority of the time, the Committee found that LGBT people do not in fact always receive the same level of service as non-LGBT people. The evidence gathered also illustrated that across many health areas such as smoking, alcohol abuse and even cancer, the LGBT population had poorer health outcomes. The report acknowledges that although few people set out to discriminate, lack of training and knowledge on LGBT communities, coupled with an assumption by many healthcare professionals that sexual orientation and gender identity are not relevant, result in services that are not fully LGBT inclusive.

This debate is about the very specific area of LBT women in particular, and we know that they face particular barriers because of their gender, and when women are older, have disabilities or belong to an ethnic or religious minority, those barriers grow even larger. Those inequalities, as we have heard from the hon. Member for Livingston, take various forms. Lesbian, bisexual and trans women can often face discrimination and poor treatment when accessing general healthcare services. When they have experienced, or expect to experience, inappropriate questions, misgendering or homophobic, biphobic and transphobic comments, as well as ignorance of their health needs, such as incorrectly advising lesbian women they do not need smear tests, it can deter lesbian, bisexual and trans women from accessing healthcare when they need it We also know that the waiting times for gender identity services, averaging a two to three-year wait, are simply too long. Research shows that LBT women experience higher rates of poor mental health, and yet they have significant difficulties in accessing mental health support.

There are other worrying statistics, such as that bi women are more than twice as likely to have cervical cancer as heterosexual women, and lesbian and bi women are more likely to describe themselves as having fair or poor health than heterosexual women. As the Royal College of Obstetricians and Gynaecologists points out, those figures highlight something wrong in the prevention, diagnosis and treatment of those conditions.

In July 2018, the Government published their LGBT survey and action plan, which clearly identified the health disparities facing LGBT people and committed to ensuring that LGBT people’s needs will be at the heart of the national health service. The survey was remarkable: 108,000 people participated, making it the largest survey of LGBT people in the world to date and thus an incredibly valuable resource to understand better the needs of the whole LGBT community.

It is encouraging to see the Government’s focus on delivering some of the health-related commitments in the action plan, which I greatly welcome. The appointment of an LGBT advisory panel made up of representatives from the LGBT field is also a welcome action by the Government, as is the appointment of Dr Michael Brady as the first national adviser on LGBT health. The funding pilot on LGBT health is another initiative that I am sure Members on both sides of the House will welcome, but there is still a vast amount of work to do to close the gap. I will focus on some of the recommendations in the Select Committee report, particularly those relating to LBT women.

First and foremost, we must ensure that, where multiple initiatives, agencies, action plans, advisers and Departments are working on an issue, they do so in a co-ordinated manner to increase their effectiveness. In relation to LBT women’s rights specifically, as well as those of the whole LGBT community, we must ensure that the Government Equalities Office, which has responsibility for the action plan, and the Department of Health and Social Care, which has oversight over the NHS long-term plan, collaborate to ensure that LGBT-inclusive healthcare is mainstreamed across the NHS England strategy and to ensure that its implementation is the responsibility of health and social care institutions, and not solely of the Government Equalities Office.

Those organisations need to ensure that data collection on both sexual orientation and trans status is introduced to prevent health disparities being hidden, and they need to ensure such data collection acknowledges that some women can be lesbian or bisexual and transsexual. The Select Committee report recommends that sexual orientation monitoring should be made mandatory across the NHS, and that there should be a timeline for implementing mandatory monitoring on both sexual orientation and trans status, calling it

“far too important to be an aspiration rather than a concrete goal with clear timelines for delivery.”

I hope today’s debate prompts the Minister to review plans for mandatory monitoring.

In addition, LGBT+ issues are routinely omitted from needs assessments and planning, resulting in a lack of necessary services for the LGBT community. That must change and, given the unique challenges faced by LBT women, special attention must be given to their unique needs. The solution should be simple: all commissioning outcomes frameworks should have the explicit requirement to consider the needs of the LGBT community, with specific consideration of LBT service users.

Equalities training for frontline staff must be improved and made mandatory to ensure high-quality and consistent delivery across all our services. That will empower health professionals to provide appropriate care so that LBT women are treated with the dignity and respect they deserve, as well as helping NHS and social care staff to identify discriminatory behaviour. Initiatives such as the NHS rainbow badge are a welcome start; it should be noted that it was started and continues to be run by individuals at trust level, not by NHS England, but there is clearly much more to do.

Professional registration bodies also have a role to play in developing training, as well as in making sure they include non-stereotypical examples of LBT women in their educational and training materials so that their students are aware of the specific needs of LBT women.

Finally, with a large task ahead, it is clear that Dr Brady’s role as the national health adviser on LGBT health must continue, yet continued funding for his role has yet to be confirmed. The health adviser not only needs his position to continue but needs increased resources and authority to make the structural changes needed to improve LBT women’s health, and I hope my hon. Friend the Minister can help make that happen.

Looking internationally, the UK has taken up the co-chairship, with Argentina, of the Equal Rights Coalition, an intergovernmental organisation that exists to protect the rights of lesbian, gay, bisexual, transgender and intersex people. As part of this role, and in upholding a commitment in the LGBT Action Plan, UK Government will hold an international LGBT conference, which will present a unique opportunity to raise issues such as LBT women’s health inequalities in an international sphere. I hope we will all be putting that event into our diaries. At the moment, it is due to sit on 27 to 29 May —coronavirus possibly puts it in some doubt, but we shall see.

In summary, progress has been made in this area, and in a context where the United Kingdom has been in a globally leading role. However, legal equality does not deliver practical equality on the ground. We must be more co-ordinated, and more effective in the collection of data and on training, and funding for initiatives needs to be made central and permanent until that inequality is addressed. LBT women’s specific health and social care needs will not otherwise be adequately met. Much overdue improvement is happening in the area of women’s rights generally, and of course more needs to happen. Weeks such as LBT Women’s Health Week are hugely important—I am very grateful to my right hon. Friend the Member for Portsmouth North for recognising that—in order to ensure we do not lose focus on this issue. That is why I am grateful to the Backbench Business Committee for giving us the time in the main Chamber to debate it. With LBT women facing the double barrier of gender and sexuality in accessing healthcare, we must ensure that LBT women’s health needs do not remain invisible.

Drug Treatment Services

Crispin Blunt Excerpts

Tuesday 16th July 2019 Westminster Hall

[Crispin Blunt (Reigate) (Con)]

I congratulate the hon. Member for Manchester, Withington (Jeff Smith) on securing this debate and on speaking so well. Happily, much of what I intended to say I now do not need to, not that I would have time to say it anyway.

I congratulate my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter); he began to get into the systemic problems in this area, which is what I want to focus my remarks on. We have a systemic problem in the assessment of the rate of return on the investment in drug treatment services, particularly compared with the rate of return on investment in law enforcement in drug policy.

According to the Government’s own statistics, we are not getting a satisfactory return at all on drug law enforcement. That is why the police’s operational policy has been progressively to withdraw from doing nugatory work, leading to effective decriminalisation in many parts of the country, simply because that is not a sensible use of resources. It certainly is a sensible use of resources to try to repair the lives of drug addicts. The cuts under the necessity of austerity, and the systemic issue that my hon. Friend referred to in respect of local authorities taking responsibility, have meant that we are making a shocking value-for-money judgment in the application of public resources in this area.

It has to be down to the Minister—no one else can do it—to review how we invest public money for the public good. That is at the kernel of this debate. If we do not make changes, enforcement authorities will continue to progressively withdraw, because they simply will not waste the public money they have been given by running ineffective operations. The just-retired chief constable of Durham, Mike Barton, is a huge authority on that, and I urge the Minister to talk to her Home Office colleagues about his experience.

There is a very clear overlap between the application of the law to drug users and recovery. One then gets into the toxic situation of stigma around those users. There is also a public health budget administered by local authorities, which are under pressure to use those resources elsewhere. People who have used drugs that we have made illegal do not get automatic support in our society, yet they are just as much part of our society as anyone else.

If we do not invest resources properly, we will simply find that we carry the burden of the consequences of the damage that has been done to all those people. There is an infinitely better way to do things, and I urge the Minister to try her hand at effecting the system change that is needed to do things infinitely better.

--- Later in debate ---

[Seema Kennedy]

I will come on to funding.

My hon. Friend the Member for Reigate (Crispin Blunt) takes great interest in this issue. He spoke about the legislative framework for drugs, which is a matter for the Home Office. As I said, I will talk to ministerial colleagues about that. The Government are putting together a formal response to the report on custody-community transitions, with input from many Departments, including the Department for Work and Pensions, the Ministry of Justice and the Home Office. I think we have until the end of the summer to issue that response.

Local authorities will want to increase the provision of naloxone to people who are not in treatment, perhaps through outreach workers, hostels or needle and syringe programmes. Public Health England is working alongside the National Police Chiefs’ Council and Her Majesty’s Prison and Probation Service and recently updated its advice and guidance on naloxone availability in prisons. The problem with drug testing kits is that not all of them are entirely accurate, which might give people false reassurance. More sophisticated testing has been available at some festivals in one pilot, but again this is a matter for the Home Office.

Hon. Members talked about the international evidence that drug consumption rooms can be effective at addressing public nuisance issues and health risks for users and for the wider public, but there is a risk that such facilities would be introduced at the expense of other more relevant, evidence-based drug services for local areas. There is currently no legal framework for the provision of drug consumption rooms, but we support a range of evidence-based approaches to reducing health-related harms. Again, we are committed to widening the availability of naloxone to prevent drug-related deaths. I acknowledge the strength of feeling on drug consumption rooms in the House.

[Crispin Blunt]

This is a narrow point, but I invite the Minister to talk about overdose prevention facilities, rather than drug consumption rooms. One can understand the difference that might make to their reception in local communities; they are about preventing death.

[Seema Kennedy]

I thank my right hon. Friend for that intervention.

Cystic Fibrosis Drugs: Orkambi

Crispin Blunt Excerpts

Monday 10th June 2019 Westminster Hall

[Paul Scully]

The right hon. Gentleman is right to say that Vertex has to be reasonable, because the UK is effectively the biggest market for a pharma company that comes in to tackle CF, for the reasons that I have mentioned. It has to understand that the issue is not all about its share price in the long term. As a free-market liberal economist, I recognise that private companies must be allowed to deliver fair profits for their shareholders, which will further research and future investment, but they are sailing close to the wind if they are profiteering from human suffering.

[Crispin Blunt (Reigate) (Con)]

I am grateful to my hon. Friend for leading the debate. I spoke in the previous debate on the subject in the main Chamber. It is right to focus on Orkambi and Vertex, but the issue is actually the process of the National Institute for Health and Care Excellence. If we cannot assess issues such as antimicrobial resistance and new antibiotics in the NICE system, or get a positive answer about them, we need to look at its assessment. I hope the Minister is open to that.

[Paul Scully]

My hon. Friend makes an interesting point. Clearly, a portfolio of drugs is coming through the system. The original drugs treated only 5% of cystic fibrosis sufferers, but now the figure is 50%. The triple therapy that is being researched can benefit up to 90%, and clinical trials show an increase of 10% in some people’s lung capacity in a single week of using the drug. It is disappointing that Vertex has not included the triple therapy in its negotiations about the portfolio. None the less, my hon. Friend is right that the NICE system needs to be reviewed to take an interesting and innovative approach to drug research in future.

Medical Cannabis under Prescription

Crispin Blunt Excerpts

Monday 20th May 2019 Commons Chamber

[Crispin Blunt (Reigate) (Con)]

It is of course a pleasure to follow the hon. Member for Manchester, Withington (Jeff Smith), my fellow co-chair of the all-party group on drug policy reform. He and I followed the hon. Member for Brighton, Pavilion (Caroline Lucas) and of course Paul Flynn, who were our predecessors as co-chairs. Madam Deputy Speaker, you have quite rightly made the point about Paul Flynn’s incessant campaigning on this issue. Tragically, for four decades in this House, he was shouting from the outside at an establishment that chose not to listen.

I am determined, in the remainder of my time in Parliament, to devote myself—as my priority issue, apart from all the things that affect Reigate and the nation—to drug policy reform. Obtaining the benefit for British patients of medicine from cannabis is an enormous potential public good. I draw the attention of the House to my entry in the Register of Members’ Financial Interests.

I welcome the Minister to her place. Her colleague Baroness Blackwood owns this issue at junior ministerial level in her Department. However, it is critically important that Health Ministers understand the potential benefit as this medicine from cannabis is developed and the potential economic benefit for the United Kingdom if we take a leading place in this industry. We have the opportunity to do so because we already do take such a place.

The Minister will be aware of the difficulties that the Home Office had when it managed this issue. I congratulate my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) on setting up the all-party group on medical cannabis under prescription, and him and the hon. Member for Gower (Tonia Antoniazzi) on their leadership on this issue.

The first urgent question on this issue was asked about Alfie Dingley by me, and my right hon. Friend, who was sitting behind me at the time I asked it, indicated his support on this issue, and he thought he had begun to open up this issue in the Home Office. However, we had the absurdity that that urgent question was answered by the Minister for Policing and the Fire Service. He had been handed the responsibility at 24 hours’ notice from the Drugs Minister, the Under-Secretary of State for the Home Department, the hon. Member for Louth and Horncastle (Victoria Atkins), not because she had any particular interest in drugs from a health perspective—obviously, the Home Office’s responsibilities include protecting the public—but because her husband is associated with British Sugar. It supplies the cannabis for a great potential British success story in the form of GW Pharmaceuticals, which is one of the global leaders in producing medicinal cannabis—just not for the British people. That is something we need to change.

I want to put this issue in its global perspective and its historical perspective. Unless we understand why there is a such a lack of understanding about this issue, and why we are so behind in the research on medical cannabis and why the medical profession is so intimidated by it, I do not think we will get the necessary pressure from the Minister and her colleagues to continue to push for the necessary advance in this area.

The reason we are so far behind lies in racist American policing of the 1950s: frankly, because African-Americans smoked this stuff, it was seen as ghastly and very dangerous. Therefore, in total disregard of the scientific evidence, cannabis was listed in schedule 1 to the 1961 UN convention, which has made it extremely difficult to research its medicinal benefits. The irony is that we have had medicines derived from opiates for an extremely long time—they are standard medical products—yet medicines derived from cannabis were put beyond the bounds of research.

GW Pharmaceuticals owes its leadership in this area to a licence issued by Lord Boateng, when he was the Minister responsible for drugs policy in the late 1990s, that allowed it in exceptional circumstances to conduct research into medical cannabis. That decision was followed by £1 billion of investment in GW Pharmaceuticals. I want the Minister to understand that it is not only GW Pharmaceuticals but a number of billion-dollar companies in North America, particularly in Canada but also in the United States, that are now investing in this area. There is a tidal wave of investor money coming into the medical cannabis business and, to an extent, the recreational cannabis business—obviously we must focus on the former. We need to ask ourselves why so many people are choosing to invest so much money in the potential of this product.

When the hon. Member for Manchester, Withington and I became co-chairs of the all-party parliamentary group for drug policy reform, our third co-chair Baroness Meacher—I pay tribute to the work that she has done to reform this area—emphasised the need to focus our efforts on securing a legal change on medicinal cannabis. In 2016, the all-party parliamentary group commissioned a report from Professor Mike Barnes—we have already heard about his research in this debate—to identify which conditions medicines derived from cannabis had been established to a medical standard to help treat.

By 2016, it was already established globally, to the highest possible medical standards, that such medicines could be used to help treat epilepsy in children and spasticity associated with MS and that they could be used as an antiemetic for those undergoing chemotherapy. However, I want to emphasise that their potential application is very much wider. The problem is that the scientific research base is in its infancy, because we put in place stupid regulations that were driven by the racism of 1950s American law enforcement, which is why cannabis was listed in schedule 1 to the 1961 convention.

The Minister will know that the National Institute for Health and Care Excellence guidelines will focus on four indications: chronic pain, multiple sclerosis, treatment-resistant epilepsy, and nausea and vomiting due to chemotherapy. However, there is substantial evidence—enough to excite investors around the world to invest billions of dollars in the potential of this medicine—that cannabis or cannabinoids will be effective in improving chronic pain in adults, chemotherapy-induced nausea, short-term sleep outcomes in individuals with deep sleep disturbance, clinician-measured spasticity symptoms associated with MS, symptoms of Tourette’s syndrome, anxiety symptoms in individuals with social anxiety disorders and symptoms of post-traumatic stress disorder. I hope that the Minister will understand that, if we can advance the science satisfactorily in relation to anxiety and depression, this is of potentially vast application.

We have to understand the range of interests arrayed against the development of medicines in this area. We should consider how policy has been developed in both North America and Germany, and indeed here, because the development has come not from the medical profession or the pharmaceutical industry but from outside. In the United States, those states that have approved the use of medical cannabis usually started the process through a referendum that then imposed the answer on the state’s legislature. Twelve of the 25 states that have medical cannabis have now moved on and established a market for cannabis for recreational adult use. An important development is that Canada, which has had medical cannabis for some time, last year introduced a market for legally supplied cannabis for recreational adult use.

I quite understand the political need, reflected in the establishment of the all-party parliamentary group on medical cannabis under prescription by my right hon. Friend the Member for Hemel Hempstead and the hon. Member for Gower, to differentiate between medicinal and recreational adult use. We must of course focus on the medicine first. There is a separate discussion to be had about the important criminal justice, societal and public health benefits that would come from being able to protect the public and children by having a legally supplied and properly regulated and licensed market. What has been absent from the wider political debate about this to date is a proper consideration of evidence. We are 50 years behind on the potential benefit to the public because we have been unable to get the evidence, and that is a result of the policy imposed through the 1961 convention.

I want to draw attention to one potential application relating to chronic pain. The United States is now coping with an opioid epidemic. Last year, 63,000 Americans died of an opiate overdose that started in the doctor’s surgery. These were not junkies on the streets; they were people who went to their doctor to get treated for chronic pain. Many of them were prescribed OxyContin, courtesy of Purdue Pharma, in circumstances that are now subject to a class action. When the state of Arizona held a referendum on legalising cannabis, the result was on a knife edge and it was not clear which side would win. I am advised that right at the end of the campaign a substantial slug of money was put in to achieve a no vote. Nobody knew at the time where the money had come from, but my understanding is that it actually came from a business associated with the rehabilitation of opiate addicts, which is truly shocking. To prevent cannabis-based medicines having an opportunity to replace the much more dangerous opiate-based medicines, which have contributed to this terrible level of dependency on a medicine that is profoundly dangerous if taken incorrectly, cannabis had to be kept out of the business.

What I want to say to the Minister is that I am anxious for the Department of Health and Social Care, in taking this issue forward, to clearly understand where all the interests are here, and, if one begins to roll this forward in the years to come with regard to the potential application, to understand what opportunities there are for the United Kingdom as a provider of medicine from cannabis. GW Pharma ought to be reinforced by other companies supplying pharmaceutical grade cannabis-derived medicinal products to people. If the conditions I listed earlier are anything to go by, this will be a multibillion dollar-industry, particularly if we can get a decent slug of the global market.

This is not just about the economic effect, however. This is about the opportunity costs of people continuing to be prescribed opiates when they could be prescribed a cannabis-based medicine. It is about the opportunity costs of people self-medicating with alcohol to deal with the aches and pains of old age, rather than understanding the benefits they could get from cannabis. We are now at the stage—the Minister will have seen the report about people who have a medical condition for which they have a diagnosis who now cannot get medical cannabis—where people are now growing their own. In certain circumstances, they are being arrested for growing their own medicine. Our policy is in a mess. It will need real drive from Ministers to get a grip of all the regulators and the medical, pharmaceutical and patient interests to keep pushing for sensible reform.

I ask the Minister and her team to look around the world at the jurisdictions leading on this issue. Look at what is happening in North America, particularly Canada and New York state, and in Germany. Germany has moved pretty rapidly following a legal action by two cannabis growers producing their own medicine. The German state lost that legal action and it now enables them to grow their own cannabis for medicine, saying that what these people need is pharmaceutical grade medicine from cannabis. Two years on, I think 80,000 prescriptions have been written in Germany for people to get medicine from cannabis. We can move relatively quickly if we have the will.

If we do not have the will, we will see the continuing misery of families with epileptic children who are chronically ill. It is quite right that End Our Pain and the all-party group have focused on those families, led so brilliantly by the Deacon family, with Alfie, and Charlotte Caldwell, with her son Billy. They are the ones who have pushed this over the line. No politician can turn around to mothers and families in circumstances where they have obtained treatment with medicine derived from cannabis and faced up to the cruelty, on their return to the United Kingdom, of that medicine being taken away from them. Billy Caldwell’s case was the one that drove the Home Secretary over the line, issuing a special licence and beginning the process of reform in this area.

I cannot find anyone in this House who does not accept the principle that if we can have medicine from the opium poppy then surely we can have medicine from a cannabis plant. Find me evidence of someone who has died of a cannabis overdose. I am told there is not any. Of course, people have died in certain circumstances relating to mental conditions associated with very heavy use, particularly by young people, of the kind of dreadful stuff sold on our streets by the criminal supply chain. But we have chosen, by the laws we have passed, to put that business in the hands of criminals who are selling the strongest and most dangerous stuff to our children. Trading Standards is not going around measuring it or checking that consumers are over the age of 18 when they purchase it. That is why it is easier for our kids to get this dangerous form of cannabis than alcohol.

We need to get to grips with an awful lot of reform in this area, but the public benefit from the United Kingdom pushing on with the science and supporting research could be huge. We in this House must remain engaged, and Ministers must really push and lead on this. My fellow co-chair of the all-party group on drug policy reform, the hon. Member for Manchester, Withington, made a very important point. There will have to be a bespoke arrangement to regulate and license the system. There is an endocannabinoid system in all animals. That is not taught at medical school. That is not currently part of standard medical training or assessment, but it would appear to be a reason why this stuff works at a common sense level. It is why, among all the people we represent, there is the knowledge that this stuff does work. That is why hundreds of thousands of people are using it to self-medicate for the conditions from which they suffer. We have to bring those people into the legal framework, so they can access the medicines that will make their lives very much easier. Many of the diseases and conditions likely to be treated by medicinal cannabis are the diseases of ageing. It would be infinitely better if people can use a safe medicine such as cannabis, rather than dangerous medicines such as opiates or legal alcohol.

I ask the Minister to push her colleagues to ensure that we do not simply follow down a pharmaceutical path that just assesses medicine as a molecule with a particular individual effect on a particular individual condition. That will not work in respect of medicines derived from cannabis. We have heard the reasons: the complexity of a plant-based medicine that has many thousands of different variants once one starts spinning them out. There should not be a choice between randomised control trials and observational trials. We need to do both. The opportunity for the United Kingdom and the people we represent—both economically in terms of a highly successful business and in improving public health and reducing the danger of opiate use and so on—is there for us to grasp. That is why investors have got it. They understand the opportunities for innovation and investment with real money in this area.

I urge my hon. Friend the Minister, now that the policy lead is in her Department and not the Home Office, to get the rest of the licensing arrangements off the Home Office and get them into a state where we advance public health, advance the economic interests of the United Kingdom and make a huge difference to public health in the UK, making people safer and healthier, and, ultimately, providing much greater value for money than the alternative treatments that people are using at the moment.

--- Later in debate ---

[John Howell]

I accept that point. In cases of children who need cannabis oil, I am aware of it being crowdfunded, which can be a valuable way of proceeding, but it seems a complete nonsense in a country that is proud of its NHS that people should have to go into the public arena to crowdfund a drug.

I have some questions about this short list that the GMC maintains of doctors who can prescribe medical cannabis. How accessible are these doctors, and what is the waiting time to see one? These are practical barriers to people getting the drugs they need.

A young girl in my constituency—her name is not important—has intractable epilepsy and there is a great hope that medicinal cannabis would improve the quality of her life. Many women who suffer the sort of pain and discomfort she suffers during her menstrual cycle take birth control pills, which eases the pain considerably, but she cannot do that because it reduces the efficacy of her epilepsy medication and leads to a radical increase in the number of serious fits. For Hannah—that is her name—her epilepsy is life-threatening, as she is in a high-risk group of epilepsy sufferers who could experience sudden unexpected death in epilepsy syndrome, and we ought to think about how we can make it easier for her to obtain these drugs and so make her life easier. I mention that because to make these points we need to bring this debate back to examples of real constituents.

My second point is that raised by my hon. Friend the Member for Lichfield (Michael Fabricant) about the availability of guidance and training. In respect of both, there is a great lack of information, and it is not just us who lack information; so does the medical profession. We should do all we can to increase doctors’ knowledge and awareness so that, among other things, we can broaden out that list and GPs and family doctors can have the information they need to make decisions. I have no problem with this being a clinical decision rather than a political decision.

[Crispin Blunt]

We are where we are only because a politician, when faced with the inhuman cruelty of taking away from two children medicine obtained overseas when they returned to the UK, in the end refused to do so and issued a special licence. If this medicine is outside the scope of conventional medicine and the conventional assessment of molecular-based medicines, something will have to give if we are to get the benefit.

[John Howell]

I agree with my hon. Friend. The in-principle decision has been taken and the practical decisions now have to be taken by clinicians who are willing and fully trained to prescribe. The press releases and parliamentary answers are full of talk about finding the limit to the use of cannabis as a medicine. I listened to an exchange—I cannot remember who it was with—on its use to treat pancreatic cancer. From memory, I think the Minister gave a rather mealy-mouthed response. We need to think about extending the limits to other diseases.

In conclusion, I go back to where I started and congratulate my right hon. Friend the Member for Hemel Hempstead on securing this debate, but the matter will not rest here. I do not think this will be the last time we have this debate. I hope we see some progress soon.

--- Later in debate ---

[Tonia Antoniazzi]

I do agree. It just does not make sense, which is infuriating, because I like to apply sense and logic to most situations, and the current situation is not logical.

Not being able to access medical cannabis leads people such as Chris and the parents of children with epilepsy to consider alternative ways of accessing cannabis, which—as has already been pointed out—is fuelling a dangerous online trade in which, for all we know, they could be buying anything. That is dangerous and wrong. Clinicians to whom I have spoken often ask parents what they have given their children in addition to over-the-counter drugs. Access to CBD alone has great health benefits that are not recognised by many in the medical profession. The right hon. Member for Hemel Hempstead has referred to its being described as homeopathy. When I say that one of my interests lies in medical cannabis, there will always be someone—even a politician—who will make the pun about wacky baccy, and it is really not appropriate. ‘

There seems to be a theoretical concern about the exposure of children to THC, but that is about recreational use; it is not about medical cannabis. Discussions about the legalisation of cannabis for recreational use and about the rescheduling of cannabis for medical use under prescription must not be conflated in the House. Let me put the position into perspective. The law changed because of one boy, Alfie Dingley, and the campaign spearheaded by his mum, the fantastic Hannah Deacon, who is in the Visitors’ Gallery today.

[Crispin Blunt]

And Billy Caldwell.

[Tonia Antoniazzi]

And Billy Caldwell, yes.

Alfie’s life has been transformed. He has been seizure-free for as long as 300 days, riding a bike and riding a horse. Hannah continues to campaign for parents who cannot gain access to medical cannabis for their children, who need the same treatment for their intractable epilepsy. The fact is that although the law has changed, the rules on access to medical cannabis are even more stringent as a result. Under the guidance provided by the British Paediatric Neurology Association, Alfie would not be eligible for his prescription, which beggars belief. The Government were aware that they were opening the floodgates by providing access for Alfie, but the push-back from certain areas of the medical profession is what is preventing any advance. We have seen that with a number of patients, and it is extremely unfair.

The medical cannabis that is being prescribed is in line with manufacturing practice, which means that it meets European standards. However, these products will have to be subjected to trials that could take three to four years, which is not acceptable to the families with whom we work at End Our Pain. It is not acceptable to the parents of Bailey Williams, who are also in the Gallery. They cannot wait any longer. They did use a CBD, and I think that they are still using it, but it is not working; it has worn off. That is why they need the THC.

These products are available, and they need to be made available to everyone now. There is currently a two-tier system. There are those who have access to medical cannabis because they have the funding, and those who do not because it is not available on the NHS. We must change that.

[Crispin Blunt]

I pay tribute to the hon. Lady for the work she is doing. The situation is worse than that, however: we are driving a number of people into the hands of a criminal supply chain so that they can obtain their medicine, and that cannot be right.

[Tonia Antoniazzi]

I entirely agree, and I am very concerned about it. We have heard in the House this evening that people are growing their own cannabis, and there is a growing trade. There is an online family of people who are helping each other to obtain the most THC possible from different combinations of different plants. It is a complete industry. Why are the Government not getting a grip, and providing a proper, GMP-standard, pharmaceutical product for people?

I also want to talk about the cost, which is extraordinary. Has the Minister or anybody in her office done a cost-analysis? Alfie Dingley’s case provides a classic example: how much has he saved the NHS by not having emergency medication and not using the ambulance service to go into hospital? It seems nonsensical that we are not going down this road.

I want to talk about a couple of my constituents. Only a few weeks ago I had a visit from the parents of a 14-year-old son. My son is 14 too, so their situation struck a chord with me. Their son has intractable epilepsy. Mum has given up her job to look after him—he has a very efficient system around him. He benefits from a ketogenic diet and the next available medicine is Epidiolex. Epidiolex does not contain THC but she wants her child to be on a trial, and the trial is limited. A mum should not come to me begging for her son to be on a trial, but when I spoke to her about medical cannabis with THC she was reluctant to engage because of a fear of breaking the law and of not following the system properly. All our families are following a system. They are at the end of the road in terms of what medicine they can be given, so I want them to be given medical cannabis with THC as soon as we can.

NHS England is drafting terms of reference, and as co-chair of the APPG I appreciate its efforts. These children must have access, however; they must not be waiting three or four years. I urge NHS England to work collaboratively with the devolved nations because we need our children in Scotland, Wales and Northern Ireland to have the same benefits.

--- Later in debate ---

[Seema Kennedy]

I thank the hon. Gentleman for his comments. Prescription is in the hands of the clinician. Whether the prescription is paid for is ruled on locally and I will talk about that later.

I would like to tell my right hon. Friend the Member for Hemel Hempstead that a report, including any recommendations, is expected shortly. We will carefully consider any further action we might take to improve access in the light of that report and the clinical guidelines that are due to be issued by NICE. Members are rightly frustrated with the slow pace, because of the distressing cases and because of examples they have seen from abroad. NICE guidelines have been expedited. They would normally take two years to produce, but these guidelines will come out in half that time, this autumn.

Members have said that patient expectations are not being met and that clinicians are taking an overly cautious approach. With new medicines, we need a strong evidence base. That base is still in development, partly because of the historical overhang.

[Crispin Blunt]

Will the Minister give way?

[Seema Kennedy]

I was about to refer to my hon. Friend, but I will let him speak for himself.

[Crispin Blunt]

The Minister was probably going to pick up the point I made about the assessment of the risk-reward ratio. Humanity has goodness knows how many thousands of years of use of this plant, and it may need a different risk-reward assessment base from the classic medical variety. Sitting in the background for all the people who regulate our medicines is thalidomide and their anxiety about what might happen. We might need a different framework for this.

[Seema Kennedy]

My hon. Friend raises an interesting point, as he always does. The normal NHS medicines governance systems apply, and they are being used to support good clinical practice and safe and effective prescribing, but we could of course do more to educate and support the health profession.

I want to pick up another point raised by my hon. Friend the Member for Henley, about who does the prescribing of these medicines. These are not frontline medicines, and it is right that specialists who have detailed knowledge of all the treatments available for these particularly difficult cases are the ones who should be responsible for prescribing. Cannabis-based products would not normally be considered until a patient was at the stage in their treatment pathway when they were under the treatment of a specialist.

On education, Health Education England has been commissioned to develop an online training package. The aim of the package is to familiarise those working in the health sector with the change in the law and provide straightforward information about the products and what is known about their mechanisms of action. It will support and underpin the knowledge and understanding gained by specialists as experience in prescribing these products grows.

NICE Appraisals: Rare Diseases Treatments

Crispin Blunt Excerpts

Thursday 21st March 2019 Commons Chamber

[Crispin Blunt (Reigate) (Con)]

I am delighted to support the motion standing in the names of the hon. Members for Blaydon (Liz Twist) and for North Tyneside (Mary Glindon). This is a life-changing issue for thousands of our fellow citizens who simply do not have time on their side. A number of my constituents, including the parents of my young constituents battling with cystic fibrosis, have brought to my attention the weaknesses in the current NICE appraisal model. I look forward to reinforcing the arguments of the hon. Member for Blaydon with some details that they have provided.

NICE’s appraisal model has led to a horrendous block on life-changing cystic fibrosis drugs being made available to those young people. Vertex’s three approved medicines and investigational triple regimen may be able to treat the underlying cause of cystic fibrosis for up to 90% of patients. There is currently no cure for cystic fibrosis, and half of people with the disease will die before they are 31. I recommend that my hon. Friend the Minister instructs NICE to review its current single technology appraisal, which is used to appraise inherited rare diseases, in order to come to a solution that can work best for all parties. The current model, which specifically affects Vertex drugs such as Orkambi, is fundamentally flawed. It directly affects the lives of not only my young constituents suffering from cystic fibrosis, but those with spinal muscular atrophy, Batten disease and PKU, to name but a few.

NICE’s single technology appraisal has been used for the past 20 years, and although it served as an important new way to assess the cost-effectiveness of new treatments, it has failed to keep pace with advances in science. No model should be biased towards favouring specific medicines, but there remains an unwillingness to accept that new precision medicines that treat the underlying cause of disease and have the potential to extend life are fundamentally different from the medicines that existed when NICE’s processes were first developed. The idea of working on an innovative new model for appraising rare diseases is also supported by the Genetic Alliance.

When performing a single technology appraisal, NICE applies the same methodology and cost-effectiveness criteria regardless of whether it is appraising a single-use medicine for an acute condition or a lifetime medicine for an inherited, progressive, incurable, life-limiting disease. The current evaluation process turns on the incremental cost-efficiency ratio, measured in quality-adjusted life years. With acute conditions resulting from shorter-term treatment, the ICER is moderated even if the drug is very costly. Conversely, with chronic and lifelong conditions, the drug must be taken every day for life, and the cost of lifelong treatment prevents downward moderation of the ICER. That means that, when evaluating medicines that extend life, those that treat conditions from which patients would die within a short period are favoured over those that would extend life far into the future.

That unfairness is doubly compounded by the fact that, when computing the number of quality-adjusted life years attributable to a treatment, NICE usually applies a “discount rate” of 3.5% per annum, based on the Treasury’s Green Book, on both the costs and health effects of the medicine by reference to how far into the future those life years will be added to the patient’s life. In essence, the longer a patient lives, the more expensive they are to the system and the higher the cost per quality-adjusted life year.

Let me give an example. If a treatment were projected to extend the life expectancy of a six-year-old cystic fibrosis patient from 47 to 57 years, the “present value” of those additional 10 years would be less than two once they were discounted. By comparison, an oncological orphan medicinal product may add five life years, starting immediately, to a patient’s life expectancy, so discounting would reduce those five years to 4.66 for the purpose of calculating quality-adjusted life years. That approach cruelly fails to account for the fact that every year of additional survival, regardless of whether it is gained in the short or the long term, will be valued equally in the mind of a cystic fibrosis patient and his or her family.

To add insult to injury, NICE currently does not take into account the fact that when medicines lose their market exclusivity after patent expiry, their cost to the NHS falls dramatically, typically by 80% to 90%. It is unrealistic to assume that a medicine would remain at its currently listed price over the entire model horizon, particularly when that can be upwards of 40 years. There is no reason why NICE could not model the effect of a post-patent expiry price reduction by reference to available evidence from the pharmaceutical market. That is yet another example of NICE’s discrimination against treatments for chronic and incurable conditions in favour of those for acute conditions.

Finally, while NICE recognises that medicines for very rare diseases—ultra-orphan medicines—need a higher threshold and more discretion in the way in which they are appraised, it does not allow cystic fibrosis medicines to be judged against that threshold. That is because, although cystic fibrosis is a rare disease globally, its prevalence in England is such that NICE insists that it is appraised via the conventional approach.

Vertex is not the only manufacturer of precision medicines for rare diseases to experience challenges with NICE. Both the Bioindustry Association and the Association of the British Pharmaceutical Industry have, on behalf of their members, repeatedly highlighted the need for NICE to be reformed, to

“take a broad view of the value of new treatments and innovations to the health service”,

and to incorporate a wider range of factors and flexibilities, beyond the standard cost per quality-adjusted life year gained. It is right for us to ensure that NICE processes are modern and up to date with the evolution of precision medicines.

My constituent Sharon Cranfield is a bit disappointed with a letter sent to the Minister by the Chairman of the Health Committee, outlining the conclusions of the Committee’s public hearing on 8 March. She says that the points that I had raised on her behalf

“appear not to have been considered and the findings of the Committee seem to lie with continuing to defend the NICE model that has been used for the last 20 years and an unwillingness to accept that they need to be re-evaluated to reflect the current and near term developments in precision medicines.”

I understand that the Committee may have advisers who were associated with the setting up of NICE. I think that Ministers, NICE, and everyone who is engaged in this should look forward to a model that will actually work for the people whom we represent.

NICE must re-evaluate the way in which it values rare disease medicines. I sincerely hope that following today’s debate, it will do more to achieve alignment on value, evidence and price for the sake of patients, and will address, once and for all, the limitations of the current NICE STA process for diseases such as cystic fibrosis. That would also benefit all the other patients who already suffer enough after being diagnosed with a rare disease.